Health policies and data

Graph of the Month

Countries’ readiness to use electronic health data for quality improvement

Data governance and technical/operational readiness to develop national information from EHRs in countries surveyed, 2016

Many countries are now developing new datasets and publishing information from Electronic Health Record (EHR) data for the purpose of quality improvement and monitoring healthcare performance.

Countries are at very different points on this journey, however. Some demonstrate high data governance and technical / operational readiness to do this. Other countries are advanced in only one of these two dimensions, and a small group of countries are not advanced in either dimension. Countries reporting high readiness on both dimensions also reported that it was likely or very likely that EHR data would contribute to national monitoring of health care quality over the next five years.

Estimated proportion of inappropriate antimicrobial use by type of health care service

The inappropriate use of antimicrobials is perhaps one of the most threatening forms of wasteful clinical care because it encourages the development of antimicrobial resistance. Inappropriate use represents about 50% of all antimicrobial consumption by humans, but may be as high as 90% in general practice.

More rational antimicrobial consumption can be achieved with behavioural change interventions, notably antimicrobial stewardship programmes which combine multidisciplinary activities to steer both prescribers and the public towards appropriate use of antimicrobials. Mandating the use of rapid diagnostic testing can help clinicians target their antibiotic use. Economic incentives for providers and care seekers can also encourage appropriate antimicrobial consumption.

Note: Numbers in brackets indicate the number of studies used to determine the range of inappropriate use. Source: OECD analysis of available evidence published in literature.

Employment rate among people aged 50-59, with and without chronic diseases, 14 European countries, 2013

People with chronic diseases, such as diabetes, heart problems and arthritis, have lower employment rates, because they leave employment earlier or have greater difficulties re-entering the job market. Based on the latest wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), 70% of people aged 50–59 with 1 chronic disease and 52% of those with 2 or more chronic diseases were employed in 2013, compared with 74% of those with no chronic disease, on average across 14 European countries.

Greater efforts are needed to prevent chronic diseases among the working-age population and also to better integrate health and labour market policies to reduce the negative labour market impacts of these health problems.

Only half of people aged over 65 were vaccinated against influenza in 2014 on average across OECD countries, a proportion that has remained stable over the past ten years on average and has declined in several countries. Only a few OECD countries are meeting the WHO recommendation of 75% vaccination coverage in this age group.

A number of issues may need to be addressed to increase vaccination coverage, including a low perception of risk among older people, fear of side effects, and issues related to access and cost of the vaccine, among others.

A nine-fold difference in per capita health spending across OECD countries (from the highest to the lowest)

Health expenditure per capita, 2015Per capita USD PPP

How much a country spends on health can be the result of a wide array of social and economic factors, as well as the financing and organisational structures of a country’s health system. At the same time, there is a strong relationship between the overall income level of a country and how much the population of that country will spend on health.

In 2015, the United States continued to outspend all other OECD countries by a wide margin, with the equivalent of USD 9 451 for each US resident. This level of health spending is two-and-a-half times the average of all OECD countries (USD 3 814) and around twice as high as in some other G7 countries including Germany, Canada and France. Countries spending less than half the OECD average include many of the central European members of the OECD, such as Hungary and Poland, together with Chile. The lowest per capita spenders on health in the OECD were Mexico and Turkey with levels of less than a third of the OECD average.

Overall, almost three-quarters of health care spending was financed through government schemes and compulsory health insurance in 2015 with the ranking by government and compulsory insurance spending similar to overall health spending. Of all the OECD member states, only in the United States does voluntary health insurance and private funding such as households’ out-of-pocket payments account for more than 50% of the total, although Mexico and Korea also have relatively high shares of private spending.

The remuneration of specialist doctors has grown faster than that of generalists in many OECD countries

Growth in the remuneration of GPs and specialists, 2005-2014 (or nearest year)

The remuneration gap between specialists and general practitioners has continued to widen over the past decade in many OECD countries, reducing the financial attractiveness of general practice. Since 2005, the remuneration of specialists has risen faster than that of general practitioners in Canada, Finland, France, Hungary, Iceland, Israel, Luxembourg and Mexico. On the other hand, in Belgium and the Netherlands, the gap has narrowed slightly, as the income of GPs grew faster than that of specialists.

Most OECD countries have increased substantially the number of students in medical and nursing education programmes since 2000, in response to concerns about possible shortages arising from the retirement of the “baby-boom” generation of doctors and nurses and greater health care needs of ageing populations. As a result, the number of medical and nursing graduates has grown steadily, so that the overall number of medical graduates across the 35 OECD countries was 32% higher in 2014 than in 2000, while the number of nursing graduates grew even faster by 76% between 2000 and 2014.

In the United States, the number of medical graduates increased by 28% between 2000 and 2014, whereas the number of nursing graduates more than doubled during that period in response to concerns around 2000 that there might be a big shortage of nurses in the years ahead. There has also been strong growth across the 22 EU countries that are OECD members, with the number of medical graduates rising by 37% between 2000 and 2014 and the number of nursing graduates by 48%. The increase has been more modest in Japan and Korea, with a rise of 7% in the number of medical graduates and 35% in the number of nursing graduates in these two Asian countries.

The steady rise in the number of new medical and nursing graduates over the past 15 years, combined with the immigration of foreign-trained doctors and nurses in some countries, has generally exceeded the number of doctors and nurses leaving the profession. This explains why the number of doctors and nurses, both in absolute numbers and on a per capita basis, has increased since 2000 in nearly all OECD countries.

Inpatient and outpatient medical services, as well as ancillary services (imaging and lab tests) are better covered by basic health coverage schemes than other types of care. Coverage for pharmaceutical spending is typically lower, due to often-higher cost-sharing and the possibility of self-consumption. Basic health coverage schemes cover about half of spending in dental care in a handful of countries (Austria, Belgium, Czech Republic, Luxembourg, Slovak Republic, and Slovenia) and three-quarter in Japan.

Note: In many OECD countries the basic health coverage is publicly provided. In Germany these estimations were not possible to produce; other countries did not provide data. Outpatient primary and specialist care data do not include dental care; transport is not included in ancillary services.

Pharmaceutical spending has been increasing at a slower pace since the mid-2000s but the proliferation of high-cost specialty medicines will be a major driver of health spending growth in the coming years

Prior to 2000, increased spending on retail pharmaceuticals acted a major contributor in driving up overall health expenditure and, as a consequence, the health sector share of GDP. Particularly during the 1990s and early 2000s, average real annual growth in pharmaceutical spending outpaced overall health spending growth. However, during the 2000s there was a notable shift with a significant drop in average pharmaceutical growth during the second half of the decade which intensified through the global economic crisis.

Across OECD countries, pharmaceutical spending reached around USD 800 billion in 2013, accounting for about 20% of total health spending on average when pharmaceutical consumption in hospital is added to the purchase of pharmaceutical drugs in the retail sector. The OECD Working Paper looks at recent trends in pharmaceutical spending across OECD countries. It examines the drivers of recent spending trends, highlighting differences across therapeutic classes. While the consumption of medicines continues to increase and to push pharmaceutical spending up, cost-containment policies and patent expiries of a number of top-selling products have exerted downward pressure on pharmaceutical expenditures in recent years. This resulted in a slower pace of growth over the past decade.

The paper then looks at emerging challenges for policy makers in the management of pharmaceutical spending. The proliferation of high-cost specialty medicines will be a major driver of health spending growth in the coming years. While some of these medicines bring great benefits to patients, others provide only marginal improvements. This challenges the efficiency of pharmaceutical spending.

The proportion of LTC recipients aged 65 and over receiving long-term care at home has increased over the past ten years

Share of long-term care recipients aged 65 years and over receiving care at home, 2000 and 2013 (or nearest year)

‌‌‌‌‌‌

Many older people who need long-term (LTC) care prefer to remain in their own home for as long as possible, and most OECD countries aim to support them to do so. Over the last decade, nearly all countries for which we have data have seen an increase in the proportion of LTC users living at home, with particularly large shifts in France, Sweden and Korea. The only exception to this trend is Finland, but this reflects an increase in the use of specially adapted “service housing” where 24-hour care is available, rather than traditional care institutions.

While an increase in home care is a positive change that can help people to remain independent and engaged with their community, it does create some new challenges. People with LTC needs living at home are usually cared for, at least in part, by their family and friends. This can put a strain on those providing care, which can affect their health and make it difficult for them to work. A shift towards care at home means that policies to support carers are more important than ever.

There is also some evidence that severely dependent people, especially those with dementia, can be at greater risk of hospitalisation when living in their own home, compared to being in an institution. This risk needs to be considered when deciding on the best place to care for someone.

Employment in health and social work as a share of total employment, OECD countries, 2000 and 2014 (or latest year available)

‌‌‌‌‌

Employment in the health and social sector represents a large and growing share of total employment in many OECD countries. On average, health and social work accounted for more than 10% of total employment in OECD countries in 2014, up from less than 9% in 2000. This employment share is particularly large in Nordic countries and the Netherlands, where jobs in health and social work represent 15-20% of total jobs.

Cancer is the second leading cause of death in OECD countries, accounting for 25% of all deaths on average. But there are wide variations in cancer mortality rates across countries, and weak correlation with overall life expectancy. This may be in part because as mortality from other causes falls and people live longer, cancer risks can increase. Countries can be thought of as broadly falling into four groups.

‌‌‌‌

‌

1 - Short life expectancy and high cancer mortality: people die relatively early and a lot of them die of cancer. These countries face the greatest challenges in tackling cancer.

2 - Short life expectancy and low cancer mortality: people die relatively early but it tends to be of causes other than cancer. Many people may just not be living long enough to suffer from cancer. If mortality from other causes reduces, cancer mortality might rise.

3 - Long life expectancy and high cancer mortality: as all-cause mortality reduces and people live longer, cancer risks increase. Tackling cancer is central to further improvements in life expectancy.

4 - Long life expectancy and low cancer mortality: people live for a long time yet are still less likely to die of cancer than in other countries.

The number of visits to emergency departments has increased over the past decade in almost all OECD countriesNumber of visits to emergency department per 100 population, 2001 (or nearest available year) and 2011 (or most recent year)

‌‌

Note: Due to different definition and identification of emergency care services caution is needed when comparing OECD countries. Some countries include both ambulatory and inpatient ED visits (e.g. Australia), while other countries (e.g. Switzerland or Germany) only include inpatients ED visits (ED visits which lead to hospital admissions with a minimum of one stay and/or ED visits from patients already hospitalised). For sources and definitions by coumtry, see Table A1 and A2 in the Annex in the paper.

In 2011, the number of ED visits across OECD countries was about 31 per 100 population. The number of ED visits has increased over time in almost all OECD countries over the past decade. The number of ED visits for the 21 OECD countries for which data were available over the period increased by nearly 5.2%, from 29.3 visits per 100 population in 2001 to 30.8 visits per 100 population in 2011 (Figure 1). While the rise in the number of visits is recorded in 14 countries out of 22, the numbers of ED visits has decreased in Chile, Israel, Poland, the Czech Republic and Ireland.

Emergency department visits are more frequent in the very young and the very old, while injury diagnoses constitute one of the most common reasons for visiting hospital emergency departments.

Deaths from transport accidents are declining, but there is no room for complacencyTrends in transport accident mortality, selected OECD countries, 1990-2013

‌

Transport accidents – most of which are due to road traffic – are a major public health problem in OECD countries, causing the deaths of more than 100 000 people in 2013. But the good news is that death rates from transport accidents have come down steadily in nearly all OECD countries. Since 1990, the average OECD mortality rates due to transport accidents has fallen by more than 70%. Still, there remain considerable variation across countries, with transport accidents claiming more than five times as many lives per 100 000 population in Mexico compared to the United Kingdom. Mortality rates from road transport accidents also remain relatively high in Chile and the United States.

Much transport accident injury and mortality is preventable. The adoption of new laws and the enforcement of these laws to improve compliance with speed limits, seatbelt use and drink-driving rules can help in further reducing the burden of road transport accidents. Now is not the time to become complacent about dangerous driving.

Timely surgery can be considered an indicator of the quality of acute care received by patients with hip fracture.

Looking at the proportion of hip-fracture repairs occurring within two days of admission in OECD countries between 2003 and 2013, the OECD average has increased from 76% to 81%. The greatest improvement was observed in Italy, where the proportion increased from 28% in 2008 to 45% in 2013, and in Israel, where it increased from 70% in 2003 to 85% in 2013.

Foreign-trained doctors working in the USA and the UK by main countries of origin

The international migration of doctors has drawn a lot of attention in recent years because of concerns that it might exacerbate shortages of skilled health workers in certain countries, particularly in developing countries that are already suffering from critical workforce shortages. The Global Code of Practice on the International Recruitment of Health Personnel, adopted by the World Health Assembly in May 2010, was designed to respond to these concerns.

Since 2000, the number and share of foreign-trained doctors has increased in many OECD countries. In 2013/2014, the United States and the United Kingdom were the two main countries of destination of foreign-trained doctors working in OECD countries, with more than 200 000 doctors trained abroad working in the United States and more than 48 000 working in the United Kingdom.

Nearly 50% of foreign-trained doctors working in the United States come from Asian countries, with those coming from India representing by far the largest number, followed by the Philippines and Pakistan. More than 10% of doctors were trained in the Caribbean Islands, but in many cases these were American students who went to study abroad and then came back to the United States to complete their post-graduate training and practice. Most foreign-trained doctors in the United Kingdom also came from Asian countries, with India also leading by a wide margin, although a growing number of foreign-trained doctors now come from other EU countries.

The share of direct spending by households in health financing is relatively stable, with exceptionsShare of households in current health expenditures 2005, 2009, 2013 (or nearest year)

In OECD countries, three quarters of health expenditures on average are paid by public sources, but about 20% of expenditures are paid directly by households, though this share varies greatly from one country to another.

Since 2005, the share of households in health financing has remained relatively stable in the OECD countries, with some exceptions: declines in Mexico, Chile and Turkey correspond to an increased population coverage; and increases have been observed in Hungary, Portugal and the Czech Republic especially since the crisis.

Growth rate in income of nursesEvolution in the remuneration of hospital nurses, selected OECD countries, 2005-13 (or nearest year)

‌

The remuneration level of nurses is one of the factors affecting their job satisfaction and the attractiveness of the profession. It also has a direct impact on costs, as wages represent one of the main spending items in health systems.

In many countries, the remuneration of nurses has been affected by the economic crisis in 2008, but to varying degrees. Outside Europe, the growth in the remuneration of nurses in countries such as the United States, Australia and New Zealand slowed down temporarily following the economic crisis, while the crisis did not appear to have any effect on the growth rate in nurse remuneration level in Mexico. In Europe, following the economic crisis, the remuneration of nurses was cut down in some countries, such as in Hungary and Italy, and has been frozen in Italy over the past few years. In Greece, the remuneration of nurses has been reduced on average by 20% between 2009 and 2013.

Caesarean section rates have increased in most OECD countries, with the average rate going up from 20% in 2000 to 28% in 2013. The rise has been particularly strong in middle-income countries like Turkey, Mexico and Chile, where c-section rates now accounts for 45% or more of all deliveries.

This rate is three times higher than in Nordic countries (Iceland, Finland, Sweden, Norway) and in Israel and the Netherlands. Italy provides an example of a country that has been able to reverse the previous trend of rising c-section rates, although there is still room for further reduction particularly in those Italian regions where the rate remains very high.

The burden of cancer mortality in OECD countriesMain causes of cancer deaths among men and women in OECD countries, 2013

Cancer is the second leading cause of death in OECD countries after cardiovascular diseases, accounting for 25% of all deaths in 2013.

Lung cancer is still by far the most common cause of death from cancer among men (26%), followed by colorectal cancer (11%) and prostate cancer (9%). Lung cancer is also the most common cause of cancer mortality among women (17%), followed by breast cancer (15%) and colorectal cancer (12%). Further reductions in smoking is key to reducing mortality from lung cancer.

Highly educated men and women live longerGap in life expectancy at age 30 by sex and education level across OECD countries, 2012

‌‌

There have been huge gains in life expectancy across OECD countries over the past decades, but large disparities remain across socio-economic groups.

In all countries, the richest and the most educated are in better health and live longer. At age 30, women with the highest level of education can expect to live four years longer than those with the lowest level of education on average across OECD countries, while the gap reaches almost eight years between the most educated and least educated men. Differences in life expectancy by education level are particularly large in Central European countries, especially among men. This is largely explained by the greater prevalence of risk factors among men, including greater tobacco and alcohol use.

Note: The figures show the gap in the expected years of life remaining at age 30 between adults with the highest level ("tertiary education") and the lowest level ("below upper secondary education") of education.Note: The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.

Source: Eurostat database complemented with national data collected by the OECD for Israel, Mexico and Netherlands.Access the data behind the graph.

April 2015‌

Slowdown in health spending in Europe has affected all spending categories, particularly pharmaceuticals and prevention

‌ ‌

The economic crisis had a significant impact on health spending growth in many EU countries, resulting in substantially lower spending growth since 2009. The slowdown in health expenditure affected all health spending categories to varying degrees.

Both inpatient and outpatient care saw average spending growth decrease significantly, especially from 2010 onwards, in contrast to the high growth rates seen prior to the economic crisis. Pharmaceutical spending has continued to shrink, on average, for the last three years from 2010 to 2012, mainly due to government price reduction policies. Many countries also took early measures to reduce or postpone spending on prevention and public health services, with a slight recovery in spending observed since 2011.

The strong increase in 2009 is due partially to the H1N1 influenza pandemic which led to significant one-off expenditures for the purchase of large stocks of vaccines in many countries. Administration was another category immediately targeted in cost-cutting efforts, although administrative cost has started to grow again in many countries in 2012.

Dementia prevalence will continue to grow over the next 20 years, with the oldest groups becoming increasingly important

‌

Ageing societies present new challenges, such as the rising prevalence of age-related conditions like dementia. The likelihood of having dementia is strongly correlated with age. Dementia remains relatively rare in working age adults, with between 2% and 10% of cases starting before the age of 65 (World Health Organization, 2012a). However, after the age of 80, prevalence increases steeply and nearly half of all Europeans over the age of 95 have dementia.

Ageing populations therefore mean more cases of dementia. If age-specific prevalence rates are assumed to remain constant, demographic change has led to a 50% increase in overall prevalence in Europe over the last 20 years and we should expect a similar increase in the next 20 years. There will be a particularly rapid increase in the number of people over 95 with dementia.

The development of same-day surgery is made possible by continuous improvements in anaesthetics and surgical techniques, and is seen as an important way to achieve efficiency gains in health care delivery by reducing the cost per intervention.

A cataract surgery using modern techniques should not normally require any hospitalisation, except in rare cases. Nearly all cataract surgeries are performed on a same-day basis in many OECD countries, including in Canada, Belgium, the Netherlands, Spain, Sweden and the United Kingdom. In France and Italy, the share of cataract surgeries performed as day cases has increased rapidly over the past ten years and accounted for over 80% of the total in 2012, but there is still some way to go in these two countries to move closer to 100%.

Tonsillectomy – the removal of tonsils (glands at the back of the throat) – is one of the most frequent surgical procedures on children. Although the operation is performed under general anesthesia, it is carried out mainly as a same-day surgery in many countries, including Belgium, Canada, the Netherlands and Sweden. However, in France, Italy and Spain, only between 20% to 30% of children and other people having a tonsillectomy return home the same day.

A coronary angioplasty is the most common procedure to treat patients suffering from ischaemic heart disease (obstructed arteries). In all countries, this procedure usually involves keeping the patient at least one night in hospital, although some countries have seen a development of this procedure on a same-day basis also. In the Netherlands and the United Kingdom, the share of coronary angioplasties performed as day cases now exceeds 20%, while such procedures remain almost non-existent in France and Italy.

Source: OECD Health Statistics 2014, available in OECD.Stat. Data for more countries are available in the dataset on Health Care Utilisation, query "Surgical procedures (shortlist)".Access the data behind the graphs.

January 2015‌

Unprecedented speed of population ageing in the Asia/Pacific regionShare of the population aged over 65 and 80 years, 2012 and 2050

‌ ‌‌

Population ageing reflects the success of health and development policies over the last few decades. The share of the population aged over 65 years in Asian countries was 7%, less than half the level in OECD countries in 2012. But it is expected to nearly quadruple in the next four decades to reach 26% in 2050, surpassing the OECD average of 25%. The growth in the share of the population aged 80 years and over will be even more dramatic. On average across Asian countries, 1% of the population were aged 80 years and over in 2012 but in 2050, the percentage is expected to increase to 6%. In Japan, the proportion is expected to more than double from 7% to 16% between 2012 and 2050, but several other countries are likely to experience faster growth. Globally, the speed of ageing in the region will be unprecedented. Although the pressure of population ageing will depend on the health status of people as they become older, there is likely to be a greater demand for health care that meets the need of older people in the Asia/Pacific region in coming decades.

The number of doctors continued to increase following the economic crisis, but at a slower rate in some countriesEvolution in the number of doctors, selected EU countries, 2000 to 2012 (or nearest year)

‌ ‌

1. Data refer to doctors licensed to practice.

In most European countries, the absolute number of doctors has increased both before and after the 2008-09 economic crisis, although the number has stabilised in some countries hard hit by the recession such as Greece. In the United Kingdom, there were over 10% more employed doctors in 2012 compared with 2008 (Figure 3.1.2). Looking at the entire period from 2000 to 2012, there were 50% more doctors in the United Kingdom in 2012 compared with 2000. In the Netherlands also, the number of doctor has increased steadily since 2000, and there were over one-third more doctors in 2011 (latest year available) compared with 2000. In Germany, the number of doctors has increased slightly more rapidly since 2008 than between 2000 and 2008; overall, there were about 20% more doctors in 2012 compared with 2000.

The use of generics varies widely across OECD countriesShare of generics in the total pharmaceutical market, 2012 (or nearest year)

‌

1. Reimbursed pharmaceutical market. 2. Community pharmacy market.

All OECD countries see the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending, by offering cheaper products than on-patent drugs for an equivalent health outcome. However, in 2012, generics accounted for about three-quarter of the volume of pharmaceuticals covered by basic health coverage in the United Kingdom, Germany, New Zealand and Denmark, while they represented less than one-quarter of the market in Luxembourg, Switzerland, Greece, Italy, Japan and Ireland.

The share of the generic market in value is always lower than in volume, due to the fact that prices of generics are lower than for on-patent drugs.

People are up to 4 times more likely to receive knee replacement in some regions than in others in a given country.Regional rates of knee replacements in 2011 or latest year, standardised for differences in age and sex

‌

Knee replacement rates display high levels of variations. They vary by more than four-fold across countries. They are highest in Australia, Switzerland, Finland, Canada and Germany (above 200 per 100 000 population over 15-years old) while they are below 150 in other countries, with Israel having the lowest rate (56 per 100 000). Knee replacements also vary by two- to three-fold across geographic areas in most countries; and vary by more than five-fold in Canada, Portugal and Spain. In these three countries, however, large variations are partly explained by outliers with very low rates (Spain and Portugal) or with both high and low rates (Canada). Low rates in Spain and Portugal may be partly explained by partial coverage of data, which only include public hospitals.

Note: The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.